Joseph A. Skelton, MD, is an Assistant Professor of Pediatrics at Wake Forest University School of Medicine (WFUSM) with extensive clinical experience in the treatment of pediatric obesity. He will utilize this K23 Award to expand his clinical research skills and develop unique approaches to improving the delivery of evidence based treatment to obese children and their families. His career goal is to become an independent researcher in pediatric obesity treatment, developing and evaluating family-centered interventions to improve the quality of obesity treatment resources. Dr. Skelton will capitalize on the strong research environment and excellent mentorship of WFUSM to gain: competence in child- and family-focused research; expertise in conducting research in primary care offices and community-based settings; skill in qualitative research methods; and knowledge of satisfaction with and attrition from medical and behavioral therapies. His Career Development Plan features structured mentorship by a diverse and experienced committee, interaction and training with experienced pediatric research staff, formal educational programs, and experiential learning through the completion of the Research Plan. This research is timely and of great importance, as the prevalence of pediatric obesity continues to grow. The overarching hypothesis of the candidate's research program is that attrition from obesity treatment, a significant impediment to successful weight loss, is mitigated by patient and family characteristics and by the treatment programs themselves. The candidate will investigate attrition from treatment through the recruitment of families of obese children from 3 different treatment sites. Predictors of attrition will be determined through qualitative and quantitative study of a) characteristics of participating families (sociodemographics, structure, health, and weight status), b) characteristics of treatment programs, and c) satisfaction of families in treatment. Treatment programs will then be engaged, through interviews with key informants who are community health care providers, to modify treatments based on study findings. This proposal will provide Dr. Skelton with the skills to become an independent investigator of pediatric obesity treatment. Public Health Relevance: Effective treatments for pediatric obesity have been developed, but attrition from care is a significant impediment to improving the health of an obese child. Given the burden of childhood obesity and its complications, efforts to understand and reduce attrition hold great promise for substantial public health benefit. The same approaches developed in this research program may also be effective in reducing attrition from treatment programs for other chronic childhood diseases, thereby greatly multiplying the potential public health impact of this research agenda over the long term.